RA Messaged for August 10, 1999
PHARMACY PROVIDERS, PLEASE NOTE!!!
IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT
THE PBM HELP DESK AT 1-800-648-0790
PLEASE MAKE THE FOLLOWING CHANGES TO THE 8/15/98 VERSION OF APPENDIX A:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF.DATE |
| CALCIUM CARBONATE/MG
CARB/FA |
TABLET |
200-400-1 |
|
07/01/99 |
| CLARITHROMYCIN |
SUSP RECON |
187.5MG/5ML |
|
06/28/99 |
| FE,CARBONYL/CA CARB/FA/MV-MN |
COMB PKG |
90-1-600MG |
|
07/15/99 |
| HCTZ/SPIRONOLACTONE |
TABLET |
25/25MG |
$0.36030 |
07/26/99 |
| HETASTARCH/E-LYTES,LACTATE |
PLAST.BAG |
6% |
|
06/23/99 |
| ORLISTAT |
CAPS |
120MG (MIN AGE:21) |
|
8/15/99 |
| RESPERIDONE |
TABLET |
0.25;0.5MG |
|
07/12/99 |
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID
NOTICE TO HOSPITALS
FIMS #5744
24 HOUR INPATIENT/OUTPATIENT RULE CLARIFICATION
ALL OUTPATIENT SERVICES PERFORMED WITHIN 24 HOURS OF THE INPATIENT
ADMISSION SHOULD BE INCLUDED IN THE INPATIENT STAY.
SPECIFICALLY, ALL OUTPATIENT SERVICES PERFORMED WITHIN 24 HOURS BEFORE
THE INPATIENT ADMISSION AND 24 HOURS AFTER THE DISCHARGE SHOULD BE
INCLUDED IN THE INPATIENT STAY.
WHEN A PATIENT HAS OUTPATIENT SERVICES PERFORMED AT ONE HOSPITAL WHILE
THEY ARE INPATIENT AT ANOTHER HOSPITAL, ALL CHARGES SHOULD BE INCLUDED
ON THE INPATIENT HOSPITAL'S CLAIM.
THE HOSPITAL IN WHICH THE PATIENT IS AN INPATIENT IS RESPONSIBLE FOR
REIMBURSING THE HOSPITAL PERFORMING ANY OUTPATIENT SERVICES DURING THE
PATIENT'S STAY.
UNTIMELY CROSSOVER CLAIMS RECOVERY
PROJECT
EARLY THIS YEAR, SOME MEDICAID PROVIDERS WERE NOTIFIED THAT A
PROGRAMMING ERROR ALLOWED UNTIMELY FILES MEDICARE CROSSOVER CLAIMS TO BE
PROCESSED AND PAID. IF YOU WERE ONE OF THESE PROVIDERS, YOU WERE ALSO
NOTIFIED OF THE CLAIMS AND AMOUNTS THAT YOU WERE INCORRECTLY PAID AND
THAT MEDICAID WOULD RECOVER THE FUNDS FROM A MARCH 1999 CHECK WRITE.
MEDICAID RECOVERED THE UNTIMELY FILED MEDICARE CROSSOVER CLAIM AMOUNTS
FROM THE MARCH 2, 1999 PROVIDER CHECK WRITE; HOWEVER, DUE TO THE AGE OF
SOME OF THE CLAIMS, THE ENTIRE AMOUNT MAY NOT HAVE BEEN RECOVERED. IF
YOU ARE A PROVIDER WITH AN OUTSTANDING BALANCE, MEDICAID WILL RECOVER
THE BALANCES FROM THE AUGUST 10, 1999 CHECK WRITE. THESE AGED CLAIMS
ARE NO LONGER IN MEDICAID HISTORY; THEREFORE, EACH CLAIM WILL NOT BE
LISTED AND THE RECOVERY WILL APPEAR ON THE REMITTANCE NOTICE AS AN AUDIT
ADJUSTMENT.
ALL INQUIRIES REGARDING THE UNTIMELY CROSSOVER CLAIMS RECOVERY PROJECT
SHOULD BE DIRECTED TO JUDY D. CAIN AT (225)342-9463.